A systematic review of safety violations in industry

Alper, Samuel J.; Karsh, Ben‐Tzion

doi:10.1016/j.aap.2009.03.013

Cited by 152 publications

(109 citation statements)

References 103 publications

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“…These findings are consistent with other studies that have documented similar EHR barriers and workarounds in ambulatory care and other clinical settings. [23][24][25][26][27][28][29][30][31][32][33][34] However, the challenges and workarounds described in this article are specific to practices that were new to behavioral health and primary care integration and tested their EHR systems at the same time they worked to refine their care delivery approaches over a 3-year period. These practices' experiences can help shed light on challenges other practices under similar circumstances may also experience when starting the integration journey, and may help more quickly guide them to viable solutions.…”

Section: Discussionmentioning

confidence: 99%

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Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care

Cifuentes

Davis

Fernald

et al. 2015

The Journal of the American Board of Family Medicine

137

132

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Purpose: This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation.Methods: This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews.Results: Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs.Conclusion: Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. (J Am Board Fam Med 2015;28:S63-S72.)

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Section: Discussionmentioning

confidence: 99%

“…We define a workaround as a behavior adopted by a user to overcome a perceived limitation in a technical system. 22 Although not all workarounds are inherently bad, [23][24][25][26][27][28][29][30][31] they point to mismatches between capabilities of existing HIT systems and the clinical tasks practices need to perform.…”

mentioning

confidence: 99%

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care

Cifuentes

Davis

Fernald

et al. 2015

The Journal of the American Board of Family Medicine

137

132

View full text Add to dashboard Cite

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“…Lingard et al (2016) identified the violations of workers through a participatory video process, the results of which can help establish how they may function safely. Alper and Karsh (2009) argued that minimal research about violations control in work settings exist. Whether BBS interventions or safety training is used, workers' unsafe behaviors are controlled from psychological aspects.…”

Section: Control Of Worker's Unsafe Behaviormentioning

confidence: 99%

A real-time control approach based on intelligent video surveillance for violations by construction workers

Guo

Xiong

Gong

2018

Journal of Civil Engineering and Management

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Abstract. The unsafe behavior of workers is the main object of construction safety management, in which violations require increased attention due to their pernicious consequences. However, existing studies have merely discussed violations separately from unsafe behaviors. To respond quickly to workers' violations on site, this study proposes a real-time control approach based on intelligent video surveillance. First, scenes reflecting unsafe behaviors are automatically acquired through camera-based behavior analysis technology. Meanwhile, the time corresponding to the construction phase is recorded. Second, the temporal association rule model of worker's unsafe behavior is constructed, and the rule "construction phase→unsafe behavior" is determined by the Apriori algorithm to identify target behaviors necessary for critical control in different construction phases. Finally, statistical process control is used to find the trends of violations with frequency and mass characteristics through the dynamic monitoring of target behavior. In addition, real-time alerts of these unsafe acts are produced simultaneously. A pilot study is conducted on the cross-river tunnel project in Wuhan city, Hubei, China, and the violations related to construction machineries is proven to be controllable. Thus, the proposed approach promotes behavioral safety management on construction since it effectively controls workers' violations by real-time monitoring and analysis.

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“…5 Although preventing errors is a laudable goal, the fact that health care delivery requires the involvement of human providers and patients suggests that preventing all errors is not realistic. 6,7 Therefore, a process that identifies errors before they reach a patient and remediates errors to reduce harm is crucial. 6 Error recovery describes this type of process and includes 3 stages: (1) detection; (2) explanation; and (3) correction.…”

Section: What This Study Addsmentioning

confidence: 99%

Family-Initiated Dialogue About Medications During Family-Centered Rounds

et al. 2015

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BACKGROUND AND OBJECTIVE: Experts suggest family engagement in care can improve safety for hospitalized children. Family-centered rounds (FCRs) can offer families the opportunity to participate in error recovery related to children's medications. The objective of this study was to describe family-initiated dialogue about medications and health care team responses to this dialogue during FCR to understand the potential for FCR to foster safe medication use.METHODS: FCR were video-recorded daily for 150 hospitalized children. Coders sorted family-initiated medication dialogue into mutually exclusive categories, reflecting place of administration, therapeutic class, topic, and health care team responses. Health care team responses were coded to reflect intent, actions taken by the team, and appropriateness of any changes.RESULTS: Eighty-three (55%) of the 150 families raised 318 medication topics during 347 FCR. Most familyinitiated dialogue focused on inpatient medications (65%), with home medications comprising 35%. Antiinfectives (31%), analgesics (14%), and corticosteroids (11%) were the most commonly discussed medications. The most common medication topics raised by families were scheduling (24%) and adverse drug reactions (11%). Although most health care team responses were provision of information (74%), appropriate changes to the child's medications occurred in response to 8% of family-initiated dialogue, with most changes preventing or addressing adverse drug reactions or scheduling issues.CONCLUSIONS: Most families initiated dialogue regarding medications during FCRs, including both inpatient and home medications. They raised topics that altered treatment and were important for medication safety, adherence, and satisfaction. Study findings suggest specific medication topics that health care teams can anticipate addressing during FCR. WHAT'S KNOWN ON THIS SUBJECT:Family engagement in the care of hospitalized children may improve outcomes, including medication safety. Although family-centered rounds (FCRs) provide a venue for family engagement in care, how families use this venue to influence medication-related topics is unknown. WHAT THIS STUDY ADDS:Most families initiated medication-related dialogue during FCRs, discussing inpatient and home medications. Topics raised were important for medication adherence and safety, even altering treatment plans. Findings suggest specific medication topics that health care team members can anticipate addressing during FCR.

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A systematic review of safety violations in industry

Cited by 152 publications

References 103 publications

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care

A real-time control approach based on intelligent video surveillance for violations by construction workers

Family-Initiated Dialogue About Medications During Family-Centered Rounds

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